Grace Mbeki

CLM-2026-9126, Aetna, Chemotherapy, Additional Sequential (96417)

In appealWith the payer Denied claims

Billed

$2,568

denied Jan 23

Denial risk

64%

winnable with the right notes

Appeal window

lapsed

closes Apr 23

Appeals

none filed yet

What I did

and what comes next

Claim reached Heron
Posted from the 835 remittance
Jan 23
Denied by Aetna
Medical Necessity (50)
Jan 23
Heron scored it: 64% denial risk
3 factors found, appeal path chosen
Jan 23

The denial

Medical Necessity, code 50

Patient: Grace Mbeki, born 1980-03-25
Payer: Aetna
Procedure: Chemotherapy, Additional Sequential (96417)
Diagnosis: C18.9
Denied on: Jan 23, 2026
Assigned to: Heron

Heron says

Aetna denies 58% of 96417 claims without documented conservative treatment. Clinical notes supporting medical necessity were not attached to the original submission. Attach treatment history and imaging before appealing, overturn rate rises sharply with documentation.